International Journal of Pediatric Otorhinolaryngology
Congenital cysts and fistulas of the neck
Introduction
Some congenital anomalies of the neck are commonplace in pediatric practice. This is the case for thyroglossal tract cysts, unilocular branchial cysts, and fistulas of the second cleft. However, less common lesions such as fistulas of the first cleft and cysts of the fourth pouch may pose problems of misdiagnosis and recurrence. Malformation of the midline such as thyroglossal duct cysts and dermoid cysts are embryologically different from malformation of the laterocervical region. Awareness of the characteristic anatomic and clinical features of each lesion is essential not only to allow accurate diagnosis but also to achieve complete surgical excision for recurrence-free treatment. The purpose of this report is to present our 15-year experience in the management of congenital anomalies of the neck in children. Cystic hygromas and preauricular fistulas were not included in this study.
Section snippets
Embryological background
Embryological development of the laterocervical region is closely linked with that of the branchial apparatus which forms within the first month of intrauterine life. In man, the branchial arches are arranged in pairs on either side of the midline. Morphologically, the apparatus can be described as a succession of folds and grooves corresponding to the branchial clefts and pouches. Four arches can be clearly identified on the embryo. A rudimentary fifth arch appears but quickly regresses [1].
Patients and methods
Between 1984 and 1999, 191 children underwent surgical treatment for congenital cysts or fistulas of the neck in the pediatric department of Otolaryngology of La Timone Children's Hospital in Marseille, France. Embryologically, the anomalies in this series were classified as either malformations of the midline or malformation of the laterocervical region (Table 2). Anatomically the lesions could be classified as incomplete fistulas presenting a dead-end fistulous tract, complete fistulas
Laterocervical malformations
In patients involving malformations of the first arch, the course of the fistulous tract passed above the facial nerve in 12 patients, below the facial nerve in five, and between the branches of the facial nerve in two. Recurrence was observed during postoperative recovery in two children (10%) requiring re-operation within nine months. One newborn who demonstrated facial paralysis in relation with a suppurative infection of the lesion achieved complete recovery after surgery. With a mean
Discussion
Study of the cervical region has shown that the midline and laterocervical regions are embryologically distinct. Development of the laterocervical regions depends on the branchial arches while that of the midline depends on proper closure of the embryo. This difference explains the distinction that must be made between malformations of the laterocervical region and malformations of the midline.
Most reports in the literature have used the system proposed by Work (in [3]) for classification of
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